Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data

Abstract

BackgroundShort- and mid-term data on Roux-en-Y gastric bypass (RYGB) indicate sustained weight loss and improvement in co-morbidities. Few long-term studies exist, some of which are outdated, based on open procedures or different techniques. ObjectivesTo investigate long-term weight loss, co-morbidity remission, nutritional status, and complication rates among patients undergoing RYGB. SettingAn academic, university hospital in the United States. MethodsBetween October 2000 and January 2004, patients who underwent RYGB≥10 years before study onset were eligible for chart review, office visits, and telephone interviews. Revisional surgery was an endpoint, ceasing eligibility for study follow-up. Outcomes included weight loss measures and rates of co-morbidity remission, complications, and nutritional deficiencies. ResultsRYGB was performed in 328 patients with a mean preoperative body mass index of 47.5 kg/m2. Of 294 eligible patients, 134 (46%) were contacted for follow-up at≥10 years (10+Year follow-up). Mean percentage excess weight loss (%EWL) was 58.9% at 10+Year. Higher %EWL was achieved by non–super-obese versus super-obese (61.3% versus 52.9%, P = .034). Blood pressure, lipid panel, and hemoglobin A1c improved significantly. At 10 years, remission of co-morbidities was 46% for hypertension and hyperlipidemia and 58% for diabetes mellitus. Thirty patients (9%) had revisional surgery for weight regain. Sixty-four patients (19.5%) had long-term complications requiring surgery. All-cause mortality was 2.7%. Nutritional deficiencies were seen in 87% of patients. ConclusionsWeight loss after RYGB appears to be significant and sustainable, especially in the non–super-obese. Co-morbidities are improved, with a substantial number in remission a decade later. Nutritional deficiencies are almost universal.